“Endoscopy” usually means a visual examination made inside an obscure cavity using an “endoscope”, a “fibrescope”, or a “videoendoscope”.
The term “fibrescope” usually denotes a flexible endoscopic probe that is inserted into an obscure cavity so that a user can firstly observe a target located inside the cavity through a lens, and secondly modify the orientation of the distal end of the probe inside the cavity. To achieve this, a fibrescope naturally integrates an optical device, an illumination device and a mechanical device. The mechanical device of a fibrescope is composed of an articulated distal tip deflection, a control handle and four cables located inside a flexible cylindrical duct connecting the control handle to the articulated distal tip deflection. The fibrescope handle is provided with two manually controlled devices one of which acts on the pair of cables activating the orientation of the tip deflection in one plane, and the other acting on the other pair of cables activating the orientation of the tip deflection in a plane perpendicular to the previous plane. The optical device of a fibrescope is composed of an objective placed in the distal face of an end piece fixed to the distal end of the tip deflection, an optical transport system for the image output by the distal objective, the transport system being composed of a flexible beam of ordered optical fibers passing in sequence through the articulated tip deflection, the flexible duct and then in the handle and connecting the lens to the distal objective, and a lens with a dioptric adjustment fixed to the control handle that the user can use to observe the magnified image of the target located in front of the distal objective of the fibrescope and transmitted through the image optical transport system. The illumination device of a fibrescope is composed of a beam of unordered optical fibers passing in sequence in the articulated tip deflection, in the flexible duct, in the handle, and then in an umbilical cable fixed to the control handle. The distal end of the beam of fibers, housed in the distal face of the end piece fixed to the distal end of the articulated tip deflection, illuminates the observed target when its proximal end housed in an illumination end piece integrated into the connection device forming the proximal end of the umbilical cable, is connected to a light generator. Under these conditions, use of the fibrescope described above requires the joint use of a light generator.
The term “videoendoscope” usually denotes a flexible endoscopic probe that, when inserted in an obscure cavity, enables a user firstly to observe a target on the screen of a video monitor located inside the cavity and secondly to modify the orientation of the distal end of the probe inside the cavity. To achieve this, a videoendoscope naturally comprises an imagery device, an illumination device and a mechanical device. The illumination device and the mechanical device of a videoendoscope are identical to devices of the same nature integrated into a fibrescope and described above, in all respects. The imagery device of a videoendoscope comprises mainly the following elements:                an optoelectronic device housed in the distal end piece fixed to the distal end of the articulated tip deflection and comprising an objective housed in the distal face of said end piece, a color CCD sensor on the photoelectric substrate on which the real image of the observed target output by the objective is formed, and an interface microcircuit designed to correct electrical signals received or generated by the CCD sensor;        a multiconductor electrical cable routed in sequence through the articulated tip deflection, the flexible duct, the control handle and then the umbilical cable fixed to the control handle, the distal end of said cable being electrically fixed to the interface microcircuit of the distal optoelectronic device, while its proximal end is electrically fixed to a multipin connection socket integrated into the connection device forming the proximal end of the umbilical cable;        a video processor for synchronization of the electrical power supply of the distal optoelectronic device, processing of the electrical signal generated by the optoelectronic device, and outputting a video signal that is directly useable on a color monitor; the video processor with a panel of control keys enables the user to adjust the video image parameters, a video output connector that will be connected to a video monitor, and a multipin connector that will be connected to a multipin connection socket integrated into the connection device forming the proximal end of the umbilical cable of the videoendoscope.        
Under these conditions, operation of the videoendoscope described above requires joint use of a video monitor and a light generator, the light generator often being associated with the video processor of the videoendoscope in the same box.
Fibrescope or videoendoscope type flexible endoscopic probes concerned by this invention and that will be used particularly for medical applications such as bronchoscopy, also have an operating channel composed of a flexible cylindrical pipe that passes firstly in the articulated tip deflection, in the flexible cylindrical duct, then in the distal part of the control handle of the endoscopic probes. The operating channel, the distal end of which is located on the distal face of the distal end piece of the endoscopic probes, is used to carry out all or some of the following operations:                introduction of a flexible instrument such as a clamp, an electrical surgical knife, or laser fiber, that the user can use to take physical action on the target located in front of the distal objective of the flexible endoscopic probe;        suction of tissue debris at the target generated by the work done above;        distribution of a liquid medicine product at the target.        
These various operations can only be implemented if an operating device comprising the following elements is integrated into flexible endoscopic probes intended for this type of applications:                the flexible operating channel mentioned above;        a suction input fixed to the control handle and that will be connected to a suction pump through an external flexible pipe;        a control valve usually fixed to the control handle to enable the user to connect a suction input to the proximal end of the operating channel;        an instrument input fixed to the control handle and directly connected to the proximal end of the operating channel, the instrument input usually being provided with a removable silicone cap to seal the input and also to enable entry of a flexible instrument or the conical end piece of a syringe containing a product that will be injected into the operating channel.        
The architecture of the operating device of flexible endoscopic probes that enable use of the above mentioned operations must satisfy ergonomic constraints and disinfection constraints at the same time.
Ergonomic constraints relate to access to functions for “suction control” and for the introduction of instrument(s) that must be located on the control handle so as to facilitate the operator's work.
Disinfection constraints apply equally well to fixed elements in the operating device integrated into the endoscopic probe, and removable elements external to said device. Said removable elements such as the suction control valve and the sealing cap, must be either disposable, or they must be removable so that they can be cleaned by brushing before being disinfected by immersion in a disinfecting bath, or even better by putting into the autoclave. It must be easy to clean fixed elements in the operating device such as the operating channel and the various connecting pipes rigidly fixed into the control handle, using cylindrical brushes before the endoscopic probe is fully immersed in a disinfection bath.
Flexible endoscopic probes for medical purposes enabling use of a suction control and an instrumentation input, in practice are based on two types of architecture.
The first architecture routinely used in flexible endoscopic probes enabling use of a suction control and an instrumentation input concerns probes like that shown in FIG. 1, in which the control handle 1 comprises two distinct accesses 41 and 45 to the operating channel 9 connected through a tubing 12, 13 integrated into the handle 1. The first of these accesses 41, located at the distal end of the control handle 1, applies to the instrument input. The second access 45, located at the proximal part of the handle 1, is fitted with a removable external suction assembly F, and includes the suction control 30 and a suction tubing 10 comprising a connection end piece to an external suction pump. This type of operating device was described by the Japanese Company OLYMPUS in U.S. Pat. No. 5,299,561 and U.S. Pat. No. 5,840,015. Another operating device of the same type was described by the Japanese Company OLYMPUS in U.S. Pat. No. 5,257,773 and U.S. Pat. No. 5,322,263. This type of device has also been used in fibrescopes in the FB series and videoendoscopes in the EB series made by the Japanese Company PENTAX, and fibrescopes in the 40 and 160 series made by the Japanese Company OLYMPUS. The implantation of the instrument input 41 and the suction control 30 of the suction device F at the ends of the control handle 1 of the flexible endoscopic probes based on this type of architecture, has an undeniable advantage in terms of ergonomy.
It is more ergonomic to use one hand to hold the handle 1 of the probe and possibly manipulate the suction control 30 of the suction assembly F, and to use the other hand to manipulate the operating instrument inserted into the instrument input 41 that is not close to the suction control 30.
However, integration of an internal tubing 12 and 13 into the control handle 1 to connect two inputs 41 and 45 to the operating channel 9 is undoubtedly a handicap in terms of ease of cleaning and disinfection.
It is very difficult, if not impossible, to disassemble this internal tubing 12, 13 from the handle to clean it. In this case, cleaning is usually done inside the control handle at the risk of leaving impurities in the Y branch formed by tubings 13, 12, 9, a location at which tissue debris are particularly likely to collect.
The second of these architectures concerns endoscopic probes like that described in FIG. 2, in which the control handle is provided with a single unique access to the operating channel, this access being equipped with an external operating device E1, that may be fully or partially removable depending on the models, and including the instrument input, the suction control and the connection end piece to an external suction pump. This type of operating device was described by the Japanese Company OLYMPUS in U.S. Pat. No. 4,198,958, U.S. Pat. No. 4,469,090 and U.S. Pat. No. 4,561,428. Another operating device of this type was described by the Japanese Company OLYMPUS in U.S. Pat. No. 4,736,732 and U.S. Pat. No. 4,794,913. This type of device has also been used in bronchoscopes in the FBS series made by the Japanese Company MACHIDA and in bronchoscopes in the 20 series made by the Japanese Company OLYMPUS.
Direct access to the operating channel that characterizes flexible endoscopic probes based on this type of architecture has an undeniable advantage in terms of the ease of cleaning and disinfection, since the external operating device can easily be disassembled from the handle of the endoscope.
However, this single piece removable operating device E1 is not very ergonomic to use, due to the proximity of the instrument input and the suction control.